We were fortunate that our time in Washington at the same time the government was trying to get its healthcare bill through Congress. I say ‘government’ when in actual fact the government (ie the executive office functions overseen by the White House) when – unlike the strong arm approach of LBJ (or even the Bush administration) – the President had little or nothing to do with the drafting of this bill. Rather his contribution seems to have been cast more in the strategic framing of the bill:
His aim is to establish a long-term political direction — one centered on a more activist government that shapes and polices the market to strengthen the foundation for sustainable, broadly shared growth. Everything else — the legislative tactics, even most individual policies — is negotiable. He wants to chart the course for the supertanker, not to steer it around each wave or decide which crates are loaded into its hull.
To the legislation itself, the Economist gives two reasons to back it: one, decency; and two cost control. The second first:
Americas health-care system is a nightmare of perverse incentives. Because employer-provided health insurance is not considered to be a taxable benefit, people feel insulated from the real cost of their coverage and consequently over-consume. Because hospitals and medical practices in many areas face too little competition, they charge absurdly too much even for simple procedures. Because of the rapacity of Americas lawyers, the fear of lawsuits encourages doctors to practise defensive medicine, again driving up costs.
This is the libertarian trap that prefers to let freedom reign which encourage the country to consume resources simply to game the system. Thus the cost of the UK’s universal system come in at around 8% of its GDP, whereas the US system which currently excludes 45 million of its population, eats up 16% of its gross domestic product.
Even ‘Obamacare’ will leave a significant number of people outside the system. And there will be no ‘public option’ (a government-run insurance option). Medicine will remain private, but it will be regulated into ‘exchanges’ or government regulated markets in which competition will exert a downward pressure on costs, with a tax being implemented on high-cost insurance plans.
And on the decency thing, for the Economist it is simply about closing an obvious gap between the US and the rest of the developed world. And it is not about covering those currently excluded, but those wage earners whom the insurance companies consider too bad a risk to make money on:
…the much larger number of people who fear falling into that position through losing their jobs; and the larger number again who cannot get affordable insurance because they have an existing medical condition, or because they are too old, or because they have exhausted the lifetime caps imposed by insurance companies.
That said, it is still no done thing. House Democrats have – in the words of one Congressman we met last week – ‘lost the narrative’ to outlying rumours like Sarah Palin’s Death Panel story… And the Republicans are counting on fears that these reforms will play into their hands come the mid term elections in November…
That is still a long way away. Obama’s pitch to his party’s Congress caucus yesterday was that this was a straight down the middle bill, which balances fairness with an attempt to bring down America’s sky high healthcare costs… Turning the US Supertaker will take a lot longer than 7 or 8 months…
And there are a dozen other reasons to kick the government party (not least the stubbornly persistent 10% unemployment rate)… Some of those waverers must now be calculating that it is as better to be hung for stealing the proverbial sheep than a lamb…